From 06a889781f696b4cfd3346c1ca7414eb771f2c75 Mon Sep 17 00:00:00 2001 From: Mayank Date: Fri, 12 Dec 2025 15:21:35 +0000 Subject: [PATCH] added IRF PPS --- fieldExtraction/src/prompts/investment_prompts.json | 4 ++-- 1 file changed, 2 insertions(+), 2 deletions(-) diff --git a/fieldExtraction/src/prompts/investment_prompts.json b/fieldExtraction/src/prompts/investment_prompts.json index 96ada15..4e4fd36 100644 --- a/fieldExtraction/src/prompts/investment_prompts.json +++ b/fieldExtraction/src/prompts/investment_prompts.json @@ -21,7 +21,7 @@ "field_name": "AARETE_DERIVED_REIMB_METHOD", "relationship": "one_to_n", "field_type": "methodology_breakout", - "prompt": "What is the method of reimbursement? Choose only from the following valid values: {valid_values}.\nFollow these mapping rules:\n- If any of Medicare, Medicaid, Average Sales Price (ASP), AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), RBRVS (Resource-Based Relative Value Scale), RVU (Relative Value Unit) or ASA (American Society of Anesthesiology) or any type of Fee Schedule is mentioned, return 'Fee Schedule'.\n- In case of DRG, MS-DRG, AP-DRG, SDA (Standard Dollar Amount), APR-DRG, APG, EAPG, APC (Ambulatory Payment Classification)/OPPS (Outpatient Prospective Payment System) or Ambulatory Surgical Center (ASC), return 'Grouper'.\n- In case of Percent of Charge or Percentage of Billed, return 'Billed Charges'.\n- When reimbursement is defined on a per-day basis, the applicable method is Per Diem.\n- For mixed methodologies (e.g., 'cost plus 5% based on AWP'), prioritize the base method (AWP).\n\nImportant exceptions and additional rules:\n- Reimbursements with specific dollar values cannot be 'Fee Schedule'.\n- Provider interest rates are not considered 'Flat Rate'.\n- Charge master increase caps or limitations on provider pricing behavior are NOT reimbursement methodologies and should be ignored.\n- **Precedence rule (final):** If any grouper-related codes or references (e.g., DRG, MS-DRG, APR-DRG, APG, EAPG, APC/OPPS, SDA, ASC grouping, etc.) are present in the SERVICE or METHODOLOGY fields, return 'Grouper' — This **overrides all other mapping rules**, including explicit dollar amounts (normally 'Flat Rate'), Fee Schedule indicators, case rates, per diem references, or cost-based methodologies..\n- **Exception:** If the methodology explicitly maps to 'Billed Charges' (e.g., Percent of Charge, Percentage of Billed), then return 'Billed Charges' even if grouper codes are present.\n\nIf no specific rule is matched, map to the most appropriate value from the given valid values.", + "prompt": "What is the method of reimbursement? Choose only from the following valid values: {valid_values}.\nFollow these mapping rules:\n- If any of Medicare, Medicaid, Average Sales Price (ASP), AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), RBRVS (Resource-Based Relative Value Scale), RVU (Relative Value Unit) or ASA (American Society of Anesthesiology) or any type of Fee Schedule is mentioned, return 'Fee Schedule'.\n- In case of DRG, MS-DRG, AP-DRG, SDA (Standard Dollar Amount), APR-DRG, APG, EAPG, APC (Ambulatory Payment Classification)/OPPS (Outpatient Prospective Payment System) or Ambulatory Surgical Center (ASC), Inpatient/IRF Prospective Payment System, return 'Grouper'.\n- In case of Percent of Charge or Percentage of Billed, return 'Billed Charges'.\n- When reimbursement is defined on a per-day basis, the applicable method is Per Diem.\n- For mixed methodologies (e.g., 'cost plus 5% based on AWP'), prioritize the base method (AWP).\n\nImportant exceptions and additional rules:\n- Reimbursements with specific dollar values cannot be 'Fee Schedule'.\n- Provider interest rates are not considered 'Flat Rate'.\n- Charge master increase caps or limitations on provider pricing behavior are NOT reimbursement methodologies and should be ignored.\n- **Precedence rule (final):** If any grouper-related codes or references (e.g., DRG, MS-DRG, APR-DRG, APG, EAPG, APC/OPPS/IPPS, SDA, ASC grouping, etc.) are present in the SERVICE or METHODOLOGY fields, return 'Grouper' — This **overrides all other mapping rules**, including explicit dollar amounts (normally 'Flat Rate'), Fee Schedule indicators, case rates, per diem references, or cost-based methodologies..\n- **Exception:** If the methodology explicitly maps to 'Billed Charges' (e.g., Percent of Charge, Percentage of Billed), then return 'Billed Charges' even if grouper codes are present.\n\nIf no specific rule is matched, map to the most appropriate value from the given valid values.", "valid_values": "VALID_REIMB_METHODOLOGY" }, { @@ -480,7 +480,7 @@ "field_name": "GROUPER_TYPE", "relationship": "one_to_n", "field_type": "grouper_breakout", - "prompt": "Extract all grouper types from the Service and Methodology. Look for MS-DRG, APR-DRG, DRG, APC, APG, EAPG, OPPS (Outpatient Prospective Payment System), Federal/IPF Prospective Payment System and similar grouper methodologies. Follow these rules: 1) Standardize all MS-DRG variations (MSDRG, MS DRG, MSDRGs, etc.) to 'MS-DRG'. 2) Standardize all APR-DRG variations (APRDRG, APR DRG, APRDRGs, etc.) to 'APR-DRG'. 3) For other DRG variants (Ohio Medicaid DRG, Non-weighted DRGs, TDH DRG, etc.), extract only 'DRG' without prefixes. 4) Remove all descriptive prefixes - for 'Surgical MSDRGs' return 'MS-DRG', for 'Enhanced APR-DRG' return 'APR-DRG'. 5) In case of OPPS or Outpatient Prospective Payment System of any type, return 'APC'. 6) When both MS-DRG/APR-DRG and generic DRG are present in same context, extract only the specific one ('MS-DRG' or 'APR-DRG'), not both. 7) Extract only abbreviations, not full forms. If multiple different grouper types are found, separate them with commas. Do not return empty arrays, empty strings, or brackets. If no grouper methodology is found, return only N/A." + "prompt": "Extract all grouper types from the Service and Methodology. Look for MS-DRG, APR-DRG, DRG, APC, APG, EAPG, OPPS (Outpatient Prospective Payment System), Inpatient/IRF Prospective Payment System and similar grouper methodologies. Follow these rules: 1) Standardize all MS-DRG variations (MSDRG, MS DRG, MSDRGs, etc.) to 'MS-DRG'. 2) Standardize all APR-DRG variations (APRDRG, APR DRG, APRDRGs, etc.) to 'APR-DRG'. 3) For other DRG variants (Ohio Medicaid DRG, Non-weighted DRGs, TDH DRG, etc.), extract only 'DRG' without prefixes. 4) Remove all descriptive prefixes - for 'Surgical MSDRGs' return 'MS-DRG', for 'Enhanced APR-DRG' return 'APR-DRG'. 5) In case of OPPS or Outpatient Prospective Payment System of any type, return 'APC'. 6) In case of Inpatient/IRF Prospective Payment System of any type, return 'MS-DRG'. 7) When both MS-DRG/APR-DRG and generic DRG are present in same context, extract only the specific one ('MS-DRG' or 'APR-DRG'), not both. 8) Extract only abbreviations, not full forms. If multiple different grouper types are found, separate them with commas. Do not return empty arrays, empty strings, or brackets. If no grouper methodology is found, return only N/A." }, { "field_name": "GROUPER_CD",